Impact of depressed left ventricular function on outcomes in patients with three-vessel coronary disease undergoing percutaneous coronary intervention

Abstract

Background Patients with multivessel coronary artery disease and depressed left ventricular ejection fraction (LVEF) represent a high risk group of patients for coronary revascularization. There are limited data on percutaneous coronary intervention treatment in this population. Methods Among a cohort of 4335 patients with three-vessel disease with or without left main disease undergoing percutaneous coronary intervention, 191 patients had LVEF <40% (low ejection fraction (EF)) and 4144 patients had LVEF ≥40%. In-hospital and long-term outcomes were examined according to LVEF. Results The estimated two-year rates of major adverse cardiac events, cardiac death, and myocardial infarction were significantly higher in the low EF group (19.64% vs. 8.73%, Log-rank test: P <0.01; 10.30% vs. 1.33%, Log-rank test: P <0.01, and 10.32% vs. 2.28%, Log-rank test: P <0.01 respectively), but there was no difference in the rates of target vessel revascularization (6.18% vs. 6.11%, Log-rank test: P=0.96). Using the Cox proportional hazard models, LVEF <40% was a significant risk factor for cardiac death, myocardial infarction, and major adverse cardiac events (OR (95% CI): 4.779 (2.369-9.637), 2.673 (1.353-5.282), and 1.827 (1.187-2.813) respectively), but was not a statistically significant risk factor for target vessel revascularization (OR (95% CI): 1.094 (0.558-2.147)). Conclusion Among patients undergoing percutaneous coronary intervention for multivessel coronary artery disease, left ventricular dysfunction remains associated with further risk of cardiac death in-hospital and during long-term follow-up.